Faced with a decline in funding for reproductive health services (RH), regional experts have called for access to financial resources available for HIV/ AIDS programmes.According to the United Nations Population Fund (UNFPA) reports, donor expenditure for RH commodities reduced from $653 million in 1997 to $393 million in 2006, yet that for HIV/AIDS and Sexually Transmitted Diseases STDs) tremendously increased from $294 million to $5 billion.
Reproductive health experts are hopeful that the linkage between Reproductive Health and HIV/AIDS will make the abundant HIV/AIDS resources available for reproductive health.
There are coordinated efforts in mobilising resources for HIV/AIDS, which has enabled Uganda to reduce its HIV infection rates from 30% to 6.5%. Yet the country still struggles when it comes to reproductive health.
According to the 2006 Demographic and Health Survey, maternal mortality rate is at 435 women per 100,000 live births. With the estimated 1.83 million pregnancies every year, 16 women die daily due to pregnancy related cases. The infant mortality rate also remains high with 76 children dying per 1,000 live births.
Total fertility rate is still high at 6.5% compared to Kenya’s 4.5% and Tanzania’s 5.5%.
Uganda is now ranked the third fastest growing population in the world, having grown from 4.8 million in 1950 to 16.7 in 1991 and to 24.3 million in 2002. It is now estimated that Uganda’s population is 30 million. At the current rate of population growth of 3.2% per annum, it is expected to double by 2015 and be at 130 million in 2050.
“When we talk about reproductive health, we mean mobilising mothers to deliver from clinics, preventing unwanted pregnancies, etc. Those issues are not getting enough funding, yet HIV/AIDS is well funded. But the two are interrelated, for example, condoms can be used to prevent both pregnancies and transmission of HIV/AIDS,” Dr. Chris Baryomunsi told The Weekly Observer.
According to Alisemera, the widening funding gap between HIV/AIDS and RH is because many donor countries are now interested in funding programmes they identify with.
“Reproductive Health is no longer a problem to them [donor countries]. But with HIV/AIDS, one person can infect the whole world,” she said.
“Their priorities are not our priorities. Unless the leaders of Africa come out and campaign for these monies to be integrated, we shall not move. Because we are usually hungry for money, we don’t get involved into negotiations,” Alisemera said.
According to Baryomunsi, the attempt to integrate reproductive health with HIV/AIDS is gaining ground. He says, for instance, the new phase of PEPFAR (US government global anti-AIDS fund) has been adjusted to include reproductive health.
Uganda does not have a functional and secured budget line for RH commodities, including condoms. In fact, overall funding for reproductive health is small. In 2006, only 0.96% of the health budget was allocated to family planning while 66% went to medicine.
Because of limited resources, reproductive health is failing to match the growing need for family planning services.
In 2006, 41% of married women reported need to space or limit births but were not using contraceptives. This was far and above the 35% reported in 2002. Contraceptive use has stagnated at 23% in 2000 and 23.7% in 2006.
According to the Regional Advisor, UNFPA, Dr. Kechi F. Ogbuagu, about 30% of maternal deaths and 10% childhood deaths could be reduced through adequate family planning.
“Between 2000 and 2007, donors provided only five condoms per adult of reproductive age per year in Africa. UNFPA projects population of reproductive age in developing countries to increase by 23% between 2000 and 2015,” Ogbuagu noted.
According to UNFPA, 13.1 billion condoms would be needed to cover 80% of non-marital sex and 30% of the marital sex. The number of condoms used for family planning in 2005 was estimated at 4.4 billion while condoms used for HIV prevention was 6.0 billion, bringing the total to 10.4 billion condoms.